Behavioral Health

Sober Housing

A thriving industry in need of regulation

BY Sen. Karin Housley

A Lack of Oversight

Nationwide, and Minnesota is no exception, there is a serious lack of oversight in the sober housing industry, which has created large systemic issues for both patients and recovery facilities. In a world where we are facing an opioid epidemic that fosters a breeding ground for addictions, sober homes have historically provided safe and nurturing environments in which recovering residents can live and coexist while embarking down the road to recovery. Sober housing at its peak is known to offer a form of housing where people in recovery live together in a supervised, substance-free setting. Unfortunately, with a lack of oversight in this sprawling and unregulated industry, many sober homes are falling short of these expectations and are in turn also failing their residents and their recovery efforts.

Due to these concerns, the Minnesota Legislature recently passed language in the Health and Human Services omnibus bill that directs the Department of Health Services to develop industry recommendations for sober homes. These recommendations would focus on increasing access to sober housing programs, promoting person-centered practices and cultural responsiveness in the programs, considering potential areas of oversight, and providing consumer protections for individuals in these homes The language states the recommendations must be developed alongside stakeholders, so that proper input from all parties involved is considered when examining specific areas in need of oversight.

Where there should be a standard for the industry which would provide a safe baseline.

The need for support

Recovering addicts need a support system. This article provides a legislator’s perspective on the magnitude of this problem and how it is affecting a high-risk population. To understand the numerous issues surrounding the sober housing industry, it is important to understand a few important things: the scope and depth of the issues, what should be regulated and how any changes would benefit a particularly vulnerable group of citizens.

In discussing this issue, we must first break down the structure of the sober housing industry. Minnesota’s current leading authority in this area is the Minnesota Association of Sober Homes, also known as MASH, a membership-based organization that certifies homes, conducts inspections and responds to complaints. MASH currently has a membership of just under 50 sober homes throughout the state. Unfortunately, that is not an all-encompassing number. In Minnesota, membership in MASH is not required of sober homes, which means many homes exist outside of the association. Because it’s borderline impossible to find a list of all sober homes in the state, and even harder to find resident numbers, it’s impossible to know how many lives are being hurt and negatively impacted by a lack of oversight.

It’s also important to note the cost of these homes aren’t inexpensive. Member fees fall across a large range, but $550 per month for rent seems to be the most affordable; many homes also request that you call their facility to get more information on their additional specific fees. The combined cost and lack of accessibility form crippling barriers for those trying to work their way through recovery. 

Lack of regulation

The only formal regulation for sober homes is implemented at the local level through zoning and fire marshall occupancy codes. These codes are supported and loosely enforced by MASH members, this is the absolute bare minimum in terms of regulation. There are only about 30 other organizations like MASH throughout the entire country that work to ensure the safety of their state’s homes. Unfortunately, as is the case in Minnesota, many recovery homes are not part of these associations and therefore are not forced to follow minimum standards. Many of the oversight agencies and organizations are partnered with state legislatures and addiction treatment agencies to ensure the safety of their homes.

Another unfortunate note is that housing participants in sober homes are not considered renters or patients, so any laws pertaining to either of these two groups do not apply to the sober homes residents. To further compound the problem, residents often also suffer from mental illnesses; 50% of people with mental illnesses also have substance abuse disorders. A lack of oversight contributes to poor recovery outcomes, leading to adverse consequences. Implementing adequate oversight is step one, and it is the only way to overhaul this industry and provide residents the care and recovery they rightly deserve.

Minnesota is one of a handful of states working to provide greater oversight guidelines for the industry, with a goal of improved consumer protection. If we focus on these issues, we can ensure access to safe and dependable homes for recovery. Recently, Minnesota’s Office of Ombudsman for Mental Health and Developmental Disabilities expressed concerns, stating, “[the office] had concerns about the vulnerability of our clients in unregulated sober home settings after receiving complaints alleging rights violations, treatment promised but not provided, abrupt discharge without cause or due process, lack of any meaningful grievance process, and substandard living conditions.” As a result, the Substance Abuse and Mental Health Services Administration issued informal guidelines of best practices for sober homes. Many of these issues do not fall under jurisdiction of the Office of Ombudsman for Mental Health and Developmental Disabilities, yet the office still supports the study’s implementation through the Minnesota Legislature. Proper regulation will create positive living environments that offer support recovery, while also providing much-needed consumer protections. Sober homes can offer many benefits for residents, but they cannot operate at their best without proper guidance. In terms of regulation, there are a number of factors for consideration: management, physical conditions, results of the study put forward by the legislature and violation enforcement.

For example, there is currently no real training offered or required for sober housing managers. Many times, sober housing managers choose this employment option for reasons other than to help residents’ success in their path to recovery and often lack adequate knowledge and background on the connections between mental health and addiction. This need for training fails the residents on many fronts. Without a singular body to provide industry-wide standards, it’s impossible to regulate who is employed as a sober housing manager.

All signs point to the need for better regulation.

Setting the stage

Ensuring proper physical conditions for sober homes is vitally important, When someone is seeking out a sober home, they are almost always looking for a safe and stable environment, two things that are key to recovery. Most of these patients are coming to a sober house after graduating from inpatient treatment and are transitioning from being cared for to living on their own. They need guidance through an ongoing period of vulnerability and recovery. This issue is one of many where there should be a standard for the industry which would provide a safe baseline to help residents moving towards recovery. If some residents are less serious about recovery, it can hinder others around them. This difference in priorities can breed distrust and fear in the home and can lead to a decrease in the environment’s safety.

Addressing that point, there should also be a logical cap on how many residents can live in the home safely and securely, depending on adequate space and facilities. Homes should also further facilitate recovery efforts by implementing milestone requirements for tenants because recovery is an ongoing process. Although relapses happen, they should not be such a common occurrence as they are in many of these homes. If behaviors arising as part of relapse are consistently tolerated and sometimes even welcomed, it can be detrimental to multiple residents. Milestones that should be considered include ensuring residents are either holding a job or are searching for a job and actively attending meetings dedicated to recovery efforts. The standards should require homes to have a game plan for working through any type of relapse for residents.

Further factors for oversight

The above factors should be considered for regulation and oversight, purely for the safety and well-being of those working towards recovery. That is why the Legislature passed language that allows the Department of Health to develop recommendations promoting better-quality practices in the sober home industry. The language we passed was a good step forward, but there is still important work to be done, specifically in developing an authority that can exercise direct oversight for recovery homes. We should also examine the best ways to harness the medical community as tertiary support. If we had better oversight on the regulation and accreditation of sober homes and an authority responsible for rating homes based on stringent guidelines, it would not only benefit the industry as a whole, but the patients as well. Ideally and under specific guidance, if any home was to break the rules set by a presiding authority, that home’s accreditation could be lost. If we have a centralized authority with jurisdiction over sober homes, only then could we fully enforce standards and consequences, therefore keeping these homes safe and beneficial.

All signs point to the need for better regulation to reach improved outcomes. There are so many residents in these facilities who stand to gain from improved regulation. This is especially important because many individuals who develop substance use disorders are also diagnosed with mental disorders. This naturally broadens the sphere of those affected by the sober housing industry, further supporting the idea that consistent regulation would be beneficial across the board. In recent years, Minnesota has developed better oversight in the assisted living housing industry, in part due to the Legislature’s work. Now, people interested in assisted living facilities can easily research homes, view services offered and find ratings. The sober housing industry and those in it could benefit from a similar transparency.

Next steps

The industry is in desperate need of guidance, both for providing structure and stability for residents and also for offering resources to those looking to take the next step in their recovery. The study language we passed was not as encompassing as what the Senate originally envisioned—with the adopted House language, more stakeholders are involved. The increase in stakeholders can be positive when it comes to input, but can also be problematic when they have their own interests to serve. The language agreed upon will implement a study that is not as in-depth as I had hoped, but is a step in a generally positive direction. To help maximize the study’s output, it is critical we get physicians on board helping the sober housing industry.

The next step would be to harness the aid of physicians—they have depths of knowledge that can be used to advocate for better oversight and can provide input regarding what constitutes a “safe” and “effective” sober home. Physicians have a better understanding of patients’ needs, and they are able to provide better care and treatment for patients if they are aware of what progress is occurring in a sober home. Physicians also understand the important connections between substance use disorders and other disorders. This understanding will naturally lead to better-informed treatment from the doctor and a better outcome for the patient. All these resources together will help patients heal in the way they’re meant to. We cannot accomplish these changes without the support of physicians and the medical field.

Overall, I am optimistic about the study and its potential findings. If we look to physicians and their contributions to recovery efforts, we work to solve the problems of the unregulated sober housing industry. Though there is still much work to be done, we’ve taken an important step forward. In seeking to reform a broken system, in tandem with looking to physicians for guidance, we will be able to make admirable and necessary gains.

Senator Karin Housley, is the Assistant Majority Leader of the Minnesota Senate. She is from District 39, is also the chair of the Aging and Long-Term Care Policy Committee. She was elected in 2012 and has been the chief author and co-author of numerous important pieces of legislation.